.A. repiort of a joint project Toy
Hea.lt3a Service staff
oons-u.lt struts
U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE
Public Health Service
Division of Hospital and Medical Facilities
Architectural and Engineering Branch
Washington 25, D.C.
PUBLIC HEALTH SERVICE PUBLICATION NO. 930-D-3
October 1962
For salt! by the Superintendent of Documents, U.S. Government Printing Office
Washington 25, D.C. Price 35 cents.
The provision of optimum lighting conditions in patient rooms is an
important element in the design of hospital and related medical facilities.
In determining lighting requirements, consideration should be given not
only to the patient's personal needs and comfort but also to activities
which take place in the patient's room, such as nursing care, medical
examinations, test procedures, and housekeeping.
When this Hill-Burton Program activity was undertaken in 1956, the
primary aims were to determine lighting requirements and to develop light-
ing levels that might serve as criteria for illumination of patient rooms. As
the study progressed, the need was recognized for enlarging the scope of the
project to include a study on how the lighting requisites might be met most
economically and satisfactorily for both the patient and the hospital staff.
Consequently, continuation of the project was authorized on this basis; the
studies are referred to as Part I and Part II.
The recommendations in this report are based on an evaluation of the
many problems concerning artificial illumination in patient rooms in general
hospitals. The many factors which increase or lessen the reflectance or
brightness of light such as wall color and luminaire design are discussed
in some detail,
It is hoped that the findings of these studies will he useful as guidelines
for architects, engineers, and others concerned with the design of lighting
systems for hospital patient rooms.
(/ JACK C. HALDEMAN, M.D.
Assistant Surgeon General
Chief, Division of Hospital
and Medical Facilities
STUDY GROUP
The following persons were responsible for developing
the lighting studies and preparing this publication:
SPECIAL CONSULTANTS
L. RALPH BUSH ERIC PAWLEY
Consulting Electrical Engineer Research Secretary
Atlanta, Georgia American Institute of Architecture
LraoYj. BOTTOM Washington, D.C.
Consulting Engineer RUSSELL C, PUTNAM
CliSside Park, N.J. Professor of Electrical Engineering
HOWARD M. SHARP Case Institute , of Technology
Consulting Electrical Engineer Cleveland, Ohio
Past-President of Illuminating PAUL NELSON
Engineering Society Consulting A rchitect
Washington, D.C, Paris, France
PUBLIC HEALTH SERVICE
Division of Hospital and Medical Facilities
Architectural and Engineering Branch
AUGUST F, HOENACK, Chief) Architect
GEORGE IVANICK, Assistant Chief, Architect
NOYCE L. GRIFFIN, Electrical Engineer
JAMES J. PARGOE, Electrical Engineer
Professional Services Branch
BRUCE UNDERWOOD, M.D., Chief
CECILIA M.KNox,R.N.
CONTENTS
Page
FOREWORD iii
STUDY GROUP iv
SUMMARY 1
DEFINITIONS 3
SCOPE OF STUDIES 4
Facilities and Equipment Used in Determining Lighting Values 4
The Lighting Problem 4
PART I LIGHTING NEEDS 7
Lighting Practices and Requirements Surveyed 7
Common Deficiencies in Patient Room Lighting 7
Recommended Lighting Levels 8
PART II DEVELOPMENT OF LIGHTING RECOMMENDATIONS . 9
Tentative Code of Lighting Levels and Brightnesses 9
Lighting Levels: Footcandles (fc) 9
Tolerable Brightness Limits: Footlamberts (fL) 9
Luminaire Types and Service Features 9
Luminaire Case Studies 10
Lighting Affected by Surface Finishes 27
ADVISORY RECOMMENDATIONS 28
General Lighting 28
Reading Light 28
Observation Light 28
Examination Light 28
Nightlight -. . . 29
APPENDIXES
A. Medical and Related Needs for Lighting in a Patient Room in a General
Hospital 32
B. Selected Bibliography 36
ILLUSTRATIONS
1 Typical 2-bed arrangement of patient room ;>
2 Typical 4-bed arrangement of patient room ()
3 Ceiling-mounted luminaire: Public Health Service experimental imil . . It
4 Ceiling -mounted luminaire (may bo recess-mounted) 12
5 Ceiling-suspended concentric-ring luminaire, indirect lighting 13
6 Ceiling-suspended luminaire with plastic diffusing louvers, indirect
lighting 1'*
7 Ceiling-suspended luminaire with opaque shade 15
8 Ceiling-mounted floodlights; experimental lighting unit 16
9 Wall-mounted bracket light with translucent shade, indirect lighting . . 17
10 "Wall-mounted bracket light, opaque shade, indirect lighting lit
11 Wall-mounted luminaire, fluorescent and incandescent, including
examination light , 10
12 Wall-mounted luminaire, incandescent 20
13 Wall-mounted lurainairo, fluorescent 21
14 Wall-mounted bracket louvered reading light 22
15 Floorlamp portable-type luminaire 23
16 Wall-mounted nightlight with crystal glass prismatic Ions 24
17 Wall-mounted nightlight, louvered, with stainless steel face finish 25
18 Wall-mounted nightlight, louvered, matte black face finish 26
TABLES
Number p^
1 Lighting levels recommended for patient rooms ft
2 Reflectance and brightness values 27
SUMMARY
This report of lighting studies undertaken by the Public Health Service with the
assistance of special consultants provides data and guidelines to aid hospital planners
in determining the optimum lighting needs for a patient's room in a general hospital.
Recommendations are also made as to how these requirements might best be met.
Most lighting studies in patient rooms heretofore have been chiefly confined to
the problems relating to the patient's use of light during reading and resting. These
studies, therefore, were designed to be more extensive in scope. In addition to setting
forth ways to meet the various types of lighting required by patients, attention was
given other essential considerations such as:
(1) Optimum lighting conditions in the patient's room for hospital personnel
{i.e., physician, nurse, and housekeeper) performing specific functions requiring dif-
ferent levels of illumination.
(2) The effect of certain factors, such as the shape and positioning of lighting
units and reflectances resulting from the color and type of walls, ceilings, bedclothes,
and furnishings.
The team of investigators conducted its studies in specially designed mock-up
patient rooms and in several multibed patient rooms in hospitals. All persons con-
cerned, including not only the patient but also members of the hospital staff performing
various tasks in the room, were consulted as to their lighting needs and preferences.
In the mock-up rooms, many types of commercially available luminaires and experi-
mental units were installed. Detailed studies were made by varying illumination levels
and brightnesses as well as colors and reflectances of interior finishes. Photometer
readings were taken and each situation was assessed to determine optimum lighting
levels.
The importance of a close working relationship between the architect, interior
decorator, and lighting engineer is borne out by tests and studies made to determine
the extent to which lighting conditions are affected by color. Their joint efforts are
essential since good lighting design must take into account not only the placement,
shape, and type of luminaires to be used but also the brightness and reflectance values
of the surface finishes and the color of ceilings, walls, floors, and furnishings.
The reflectance factors of any color selected by the architect or interior decorator
should be shown on the architectural plans or in the specifications. By indicating
the color and reflectance values of room interiors, an effective lighting system can
be developed that takes into account the control of brightness and glare to provide
visual comfort and to lessen ocular fatigue. During subsequent redecoration of room
interiors, room finishes should be selected which will provide optimum lighting levels.
An important outgrowth of these studies has been the development of a tentative
code of lighting levels and brightnesses. Criteria for the use of these data, presented in
the advisory recommendations, are briefly stated as follows:
General lighting should be indirect or designed so that the bright-
ness of a luminaire or interior finish, when viewed from any normal in-betl
position, does not disturb patients. The luminaire should be installed m
such a manner that excessive stoottinese of the lighting in the *> e
minimized. The brightness tnus produced should not exceed 90 'foot-
lamberts. Control equipment for dimming the lights may ft." 1 advan-
lageously. Fluorescent lamps, if used in patient rooms, should be the deluxe
(warm or cool white) type.
Reading lights should provide a reasonable degree of uniformity
of lighting over a reading plane of approximately 3 square feet for an
adjustable-type unit and approximately 6 square feet for a nonadjustable-
type unit.
' Local lighting should be provided or installed where needed for
observation of specific conditions and should be positioned to light the bed
area and equipment as necessary. As this light may remain on all night,
a screen or some other provision should be made to shield the light from
other patients.
Examination lights should be of a type or so arranged to minimize
shadows at the area of interest. Such lights should be shielded or adjusted
to confine the illumination to the bed area of the patient being examined
or treated, thus minimizing glare for others in the room. Illumination
requirements for examinations and nursing service vary. For flexibility,
controls may be provided for dimming the lights as necessary, depending
on the frequency of use of these lights. Some types of luminaircs lend
themselves to dual use as examination lights and reading lights, but in most
instances, it is impractical to combine these lighting features in a single
luminaire.
Nightlights should provide a low level of illumination with a low
brightness-contrast value to minimize discomfort to patients but sufficient
for the nurse to enter the room. A control switch mounted at the door may
be provided for the nurse to switch the nightlight to a higher lighting level,
if needed.
Definitions
Brightness Photometric brightness (luminance), (B)
The luminous flux per unit of projected area per unit solid
angle either leaving a surface at a given point in a given
direction or arriving at a given point from a given direc-
tion; the luminous intensity of a surface in a given
direction per unit of projected area of the surface as
viewed from that direction. (Note: Measured in foot-
lamberts, as denned helow.)
Color temperature of alight source
The temperature at which a black-body radiator must be
operated to have a chromaticity equal to that of the light
source. (Note: Measured in degrees Kelvin.)
Footlambert (fL)
Unit of photometric brightness (luminance) equal to
I/TT (pi) candle per square foot. A theoretical perfectly
diffusing surface emitting or reflecting flux at the rate of
one lumen per square foot would have a photometric
brightness of one footlambert \\ all directions. No
actual surface completely fulfills this condition.
Footcandle (/c)
The unit of illumination when the fool is the unit of length;
the illumination on a surface one square foot in area on
which a flux of one lumen is uniformly distributed. It
equals one lumen per square foot.
Fluorescent lamp
An electric discharge lamp in which a fluorescing coating
("phosphor") transforms some of the ultraviolet energy
generated by the discharge into light.
Glare
The effect of brightness or brightness differences within
the visual field sufficiently high to cause annoyance, dis-
comfort, or loss in visual performance.
Incandescent filament lamp
A lamp in which light is produced by a filament heated
to incandescence by the flow of an electric current
through it.
Lamp
An artificial source of light; by extension the terra is also
used for artificial sources radiating in regions of the
spectrum adjacent to the visible. (A portable lighting
unit consisting of a lamp or lamps with housing, shade,
reflector, or other accessories is also commonly called a
"lamp." To distinguish between such a complete lumi-
naire and the light source within it, the latter is sometimes
called a "bulb.")
Luminaire
Complete lighting unit consisting of a lamp or lamps to-
gether with the parts designed to distribute the light, to
position and protect the lamps, and to connect the lamps
to the power supply.
Lux (fa)
The unit of illumination when the meter is the unit of
length; equal to 1 meter-candle or 1 lumen per square
meter. (Note: Ifcequalsl0.761ux.)
Reflectance
The ratio of the flux reflected by a surface or medium to the
incident flux. (Note; Usually measured in percent.)
Note: These definitions nppear in IBS Lighting Handbook, Third
Edition, 1959, published by the Illuminating Engineering Society,
New York, N.Y.
04S948 062 -2
The scope of this project is confined to studies of
lighting needs in multibed rooms in a general hospital.
Although these studies are directed to patient rooms hav-
ing two or more beds, the basic data apply equally for
single-bed rooms except that glare from patients' reading
lights would not present the same problem for this type
of room. These data may also be applicable to health
facilities other than general hospitals. However, no spe-
cific study was made for other classes of patient facilities,
such as outpatient or diagnostic and treatment areas, or
other types of hospitals.
The investigators for the first part of this project
consisted of a team of special consultants an electrical
engineer specializing in lighting problems, a doctor of
science experienced in applications of light and radiation
in health facilities, and ail ex-president of the Illuminat-
ing Engineering Society with broad experience in il-
lumination problems and the technical staff of the
Division of Hospital and Medical Facilities. For the
second part of the studies, a new team of consultants
was selected, utilizing skills similar to those of the pre-
vious group, and including two architects.
Facilities and Equipment Used in
Determining Lighting Values
Most of the studies were conducted in experimental
2-bed or 4-bed mock-up patient rooms, where the Public
Health Service staff of architects, engineers, doctors, and
lurses worked with the special consultants in determining
he lighting needs in such rooms, These mock-up rooms
[figs, 1 and 2) were equipped with hospital beds and
furniture; windows were covered to exclude daylight;
and interior surfaces were aesthetically finished in vari-
ous hues to provide specific colors and reflectance values.
Wall and ceiling luminaires with dimmers to permit ad-
justments of light levels over wide ranges were installed,
with provision for varying the light sources to produce
contrast conditions on the ceiling, walls, bedclothes, and
surface of interest, such as a book page or chart.
In the first part of this project, studies also were
done in four 2-bed patient rooms at the Clinical Center,
National Institutes of Health, Bethesda, Md, Here the
patients, attending nurses, and doctors wore consulted
on their lighting needs. These rooms wore equipped with
typical commercial lighting units: a ceiling-suspended
concentric-ring unit; a ceiling-mounted square-box unit;
a ceiling-mounted spotlight unit; and a wall-mounted rec-
tangular unit containing fluorescent lamps, The three
ceiling units had dimmers to raise or lower the lighting
intensities.
Throughout the studies, lighting levels were con-
trolled or modified by dimmers and rectifier-type
switches. 1 Measurements were made with light meters
and brightness meters. Colors and reflectances were
judged according to Munsell value scales. 3 In addition,
the reflectance values were verified by measurements with
meters.
The Lighting Problem
Lighting installations in hospital multibed patient
rooms involve many aspects that must be considered
simultaneously, The patient, the nurse, and the doctor
require different illumination levels to accommodate vari-
ous functions and services. The lighting levels required
in the rooms range from a fraction of a footcandle for
nightlighting and rest periods up to 100 footcandles or
more for critical examination or treatment. Several
steps of lighting levels within this range are needed for
patients' use and for routine nursing service.
1 Light levels controlled by; Dimmers of the autotratiaformer
types, switches of the rectifier type providing 100 percent and
30 percent of incandescent lamp intensity, ordinary "on-off"
switches, and specially made silver-bowl lamps with two elements
which were controlled by a switch in each element circuit.
'Munsoll value scales for judging color and reflectance; 19-stop
neutral scale.
Figure 1, Typical 2-bed arrangement of patient room.
INTERIOR FINISHES
Wall color Reflectances (%)
Red-
Gray.
Gray.
Gray.
26
60
50
50
White ceiling 70
Tan floor 25
TV-
A'
-w 7
Figure 2. Typical 4-bed arrangement of patient room.
INTERIOR FINISHES
Wall color Reflectances (%)
Red-
Gray.
Blue.
Gray.
26
60
40
50
^W
J\
White ceiling __ 80
Tan floor _ 25
NOTE: Ceiling height: 8 feet 6 inches.
"V
Although lighting for the comfort and personal needs
of the patient is important, the specific lighting needs of
the nurse and the doctor also must be considered. Glare
from the brightness of luminaires, interior finishes, and
other reflecting surfaces is a common complaint, Hence,
where practicable, such brightness should be kept low
enough so that seeing conditions will be comfortable for
any person in the room, particularly patients, since they
occupy the room continuously.
The lowest lighting level satisfactory for any par-
ticular seeing task in a multibed patient room is pieferable
because of the disturbing effect a higher level may have on
those patients wishing to rest.
The degree of discomfort caused by glare is related
to a person's physical well being. Nurses and doctors,
presumably well and healthy, are not discomforted by
brightnesses to the same degree as most patients. Their
main problem is getting enough light at the right location
to perform their tasks efficiently without subjecting the
patients to high, uncomfortable brightness.
Glare is frequently caused by excessive brightnesses
of room interior finishes. Both color and reflectance of
interior finishes must be a part of the planning of lighting
systems in order to select lighting equipment and designs
that will keep brightnesses within the limits recommended
(see "Tentative code of lighting levels and brightnesses,"
page 9) . Gloss finishes should be avoided.
If only minimum levels of lighting were to he sup-
plied for all the functions performed in patient rooms (see
appendix A), the lighting equipment would be too com-
plex and costly. Fortunately, several functions and see-
ing tasks may be satisfied by one lighting level. Hence,
relatively few steps of lighting levels will suffice for the
entire range of lighting needs, permitting them to be met
in a practicable and simple manner and at reasonable
cost.
The use of color in patient rooms also is related to
lighting. Customary environment becomes very im-
portant, not only for the patient, who wishes to appear as
healthy to himself and friends as he would under general
environmental conditions, but for those rendering care.
A basic illumination requirement in the hospital is that the
appearance of the patient be viewed under "normal"
lighting conditions so that the doctors and nurses can
detect at a glance any clinical changes of the skin, mucous
membranes, or eyes.
Lighting Practices and
Requirements Surveyed
To determine the lighting practices of hospitals and
the purpose for which illumination is needed, the con-
sultants surveyed a number of hospitals, conducted inter-
views with personnel and patients, and studied the
literature on hospital lighting. Visits were made to old
and new hospitals in New York and New Jersey and to
recently constructed facilities in the southeastern part of
the Nation. In addition, an analysis of the activities, and
procedures involved in medical and nursing care for
which electric lighting is required in a patient room
was made by a physician and nurse of the Professional
Services Branch, Division of Hospital and Medical Fa-
cilities, Public Health Service. This phase of the study,
reported by Dr, Bruce Underwood, is summarized in
appendix A,
For the more complicated medical and nursing pro-
cedures suggested by Dr. Underwood, an intensive study
of the lighting needs for treatment and nursing care was
done at the Clinical Center of the National Institutes of
Health. Staff members, representing the medical and
nursing fields, made observations on brightness, glare, and
comfort. Nurses, doctors, and auxiliary personnel were
asked to state their preferences as to minimum and opti-
mum lighting levels for their various functions in the
rooms. Each situation was assessed by adjusting the
illumination repeatedly, by means of a dimmer, to higher
and lower lighting levels. Photometer readings for each
specific situation were averaged.
Comfortable lighting conditions for patients' reading
also were investigated by varying the illumination on the
reading matter and the brightness on the ceiling.
From the observations mentioned, it is evident that
a multiple problem is encountered in providing electric
lighting in hospital patient rooms containing two or more
occupied beds. To provide a comfoi table seeing e
ment for patient use during the usual waking hou
eral lighting of a low level, about 10 footcandles,
be provided. Substantially higher levels of
illumination may produce an undesirable condi
direct or reflected glare within direct view of p
The maximum, general lighting suitable for patien
usually adequate for routine nursing care, but insi
for detailed reading of tliermo meters, charts, instn
and other data. Although the patient's reading lig
he used for this purpose, such practice is not desirt
cause it usually requires placing the data in the p
visual field.
For more critical examination at the patient's 3b
a higher level of illumination will be needed by the
or nurse. A separate unit should be installed or fui
for this purpose, as the patient's reading light is
considered inadequate for medical examination,
the examination light is used for relatively short ]
of time, the higher level of illumination and the ass
brightnesses could be tolerated by patients in th(
without undue discomfort.
When patients sleep or rest, a nightlight is ne<
provide only a low level of illumination to ona]
nurse to enter and move freely around the room; to
patients to orient themselves and to attend to their
self care if awakened at night; and to enable am
patients to find their way to lavatories. This SOT
light should be suitably placed ao as not to disturb p
who may be awake.
Common Deficiencies in
Patient Room Lighting
The common deficiencies noted in patient
lighting are : insufficient amount of light at locations
needed; excessive amount of light causing uncomfortable
glare in some places; and no examination light installed
in the room.
The usual causes for complaint from patients are:
glare from brightness of light sources and reflecting sur-
faces; spotty appearance of general lighting caused by
abrupt or excessive variations in brightnesses of adjacent
surfaces; lieat that radiates from reading light; reading
light that is hot to the touch; insufficient light for reading;
reading light in wrong location; excessive illumination
and/or glare from nightlight; and annoyance or disturb-
ance due to location of the nightlight.
The usual causes of complaint from the hospital staff
are: insufficient general illumination for routine nursing
care or for cleaning the room; insufficient or incorrect
type of light for examinations, giving intravenous injec-
tions, changing dressings; and other critical seeing tasks
pertinent to patients' care,
Recommended Lighting Levels
Because of the many functions performed in a single
room, the problem is not the academic one of the best
illumination for each procedure but the practical one of
providing illumination satisfactory for the most difficult
visual task. Since the illumination for the most difficult
task will only be needed periodically, the installation
should be controlled so as to provide a selection of lower
steps of illumination reasonably satisfactory for other
tasks,
From these studies and the review of the literature,
the lighting levels shown in table I are recommended.
Table 1. Lighting levels recommended for patient
rooms
Lighting needs in patient rooms
Minimum
lighting levels
(Footcandles)
1. For patient comfort:
a. Head of bed for reading.
b. Foot of bed
2, Lighting for nursing service:
a. General, for nurse to observe patient
b. Reading thermometers, charts,
directions
3. General illumination for cleaning
and routine nursing service
4. Local lighting for critical examination
by doctor or nurse
20-30
5-10
2
10-15
10
50-100
Note: Recommendations on brightness limitations which were de-
veloped during Part II of these studies are presented on the follow-
ing page.
DEVELOPMENT OF LIGHTING RECOMMENDATIONS
The findings of the first part of the studies point to
the incompatibility and difficulty in providing lighting
levels for (1) patient-use illumination localized and
minimized to be acceptable to another patient in the same
room; (2) general illumination sufficient for routine
nursing care; and (3) higher lighting level over the whole
bed for critical examinations when glare for a few minutes
may be the least of the patient's discomfort. To what
extent it may be practical to provide these three types of
illumination by less than three separate lighting fixtures
was explored in the second part of the project.
In Part II an evaluation was made of lighting char-
acteristics of various types of luminaires, both commer-
cially available units and experimental units. Details of
these case studies are shown in figures 3-18. From the
combined studies, the following tentative code of lighting
levels and brightnesses was developed. Guidance in the
use of this information is given under "Advisory Recom-
mendations" (page 28),
Tentative Code of Lighting
Levels and Brightnesses
The levels of lighting needed for particular seeing
tasks and the brightnesses which can be tolerated com-
fortably are not definite values and may vary greatly, de-
pending upon the user's needs and the patient's physical
or mental condition. However, for code purposes, defi-
nite lighting values are specified below. The practicality
of these lighting levels and brightnesses was checked when
the lighting characteristics of various types of luminaires
(figs, 3-18) were evaluated.
Lighting Levels:
Footcandles (fc)
Nightlighting; 0.5 fc, maximum, on floor, at a dis-
tance of 3 feet from the luminaire. It is desirable to pro-
vide 1% fcfor momentary use.
Observation lighting: 2 fc, maximum, 3 feet above
floor, for nurse to see the patient's apparent condition,
fluid drainage, oxygen therapy equipment, and to make
similar observations without the need for additional
lighting.
General lighting: 10 fc, for cleaning, routine nurs-
ing service, patient's self-care, visitors, dining, and as
background lighting for use with reading light.
Reading lighting; 20-30 fc, 3 feet 9 inches above
floor, on reading material of patient in bed or in chair.
Examination lighting: 50-100 fc, for use of doctor
and nurse to make critical examinations, to administer
treatments such as intravenous injections, to change
dressings, and to give other medication necessary for the
care of patients.
Tolerable Brightness Limits:
Footlamberts (fL)
General light and reading light: 90 fL, maximum
brightness of any luminaire, light source, or room interior
surface as normally seen from any normal reading or
patient's bed position,
Nightlight; 20 fL, maximum brightness normally
produced on or by the nightlight as observed from any
normal bed position. The maximum brightness for
momentary use should not exceed 50 f L.
Examination light; 250 fL, maximum brightness
of a fixed nonadjustable luminaire as seen from adjacent
beds or from beds across the room* from a normal bed
position.
Luminaire Types and
Service Features
Luminaires, which consist of complete lighting units
or components of lighting units, are commonly used in
patient rooms for one or more of the following services:
patient's reading light, general lighting, examination light,
and nightlighting. Several variations in the combination
of service features have been incorporated into commercial
units presently available. For example, a patient's read-
ing light is usually combined with some type of general
lighting component and frequently with a nightlight.
Characteristics of these lighting service featuies are as
follows:
Reading lights are supplied in adjustable and non-
adjustable types, arranged for mounting on wall, bed, or
ceiling, 01 they may be portable types such as table lamps
and floorlamps. Adjustable and poi table units require
more maintenance than nonadjustable types because of
movable parts and breakage by patients who may misuse
them when attempting to raise themselves in bed. Ex-
tension cords connecting portable lamps are dust-catchers
and dust-distributors and may constitute a tripping hazaid.
General lighting for the room is usually provided by
ceiling-mounted units, wall brackets, table lamps, or floor-
lamps. The ceiling-mounted luminaires permit a more
even distribution of lighting throughout the room than the
wall-bracket luminaires and are relatively economical.
The conventional types of wall-bracket units, table lamps,
and floorlamps that are commonly used to provide general
lighting are either deficient in lighting levels or distribu-
tion, high in brightness, or unsatisfactory for proper
maintenance.
Examination, lights used as local lighting by the
doctor or nurse to examine or treat patients are often
provided by ceiling-mounted nonadjustable units, wall
brackets with adjustable arms, or portable spotlights of
the floorstand and the hand-held types. Installed units
do not interfere with the use of both hands or free move-
ment of the doctor or the nurse while examining or
ti eating patients.
Nightlighting of low level is needed in patient rooms
for the nurse to see as she enters and as she moves wilhin
the loom, for patients to oiient themselves if awakened at
night, and if necessary, for their immediate self-care.
A i eduction in this low level is desirable when the patient
rests or sleeps. Nightlights are not intended lo supply
enough light for the nurse to observe the patient's face
or to render nursing seivice, but rather to detect whether
additional light may be needed for the patient's care. The
preferred location for the nightlight is near the floor
adjacent to the room entrance to permit a minimum, but
sufficient, amount of lighting for the nurse to enter the
room and to piovide a subdued environment for the
patient.
Luminaire Case Studies
Many different types of commercial luminairea com-
monly used in patient rooms, as well as experimental
lighting units, were installed in the mock-up rooms where
illumination characteristics, brightnesses, glare, mainten-
ance featuies, and control were studied. These case stu-
dies, as shown in figures 3-18, are not intended to identify,
praise, or censuie any luminaire, but to determine the
typical characteristics of the component parts of each
type. All lighting units were installed in accordance with
the recommendations of the manufacturers.
Figure 3. Ceiling-mounted luminaire: Public Health Service experimental unit.
Service:
Combination unit: reading, examination,
and general lighting.
Lamps :
Two 40-watt fluorescent lamps (deluxe
warm)
One 150-watt reflector flood
One 150-watt projector flood
Brightness:
Footlamberts measured at intervals across
wall and ceiling indicated by encircled
numerals.
Illumination:
Lighting levels in footcandles indicated by
numerals on beds and reading matter.
Interior finishes:
Colors and reflectances: Head walls red,
26 percent; ceiling 'gray, 70 percent.
Remarks:
The two fluorescent lamps, switched sep-
arately, provide two sources of indirect
general illumination, arranged so that
either one or both sources may be used as
desired. The reflector floodlight is for
reading. Both the reflector flood and the
projector floodlights constitute the exami-
nation light. All of these components pro-
vide the lighting levels and low brightnesses
recommended, However, the reading and
examination lights are nonadjustable and
thereby are limited to lighting a predeter-
mined area.
Viewing Position
Q Footlamberts
64B948 002 8
11
Figure 4. Ceiling-mounted luminaire (may be recess-mounted)*
X
Viewing Position
Footlamberts
Excessive Foollamberts
Service:
Combination unit; reading, nightlight, ex-
amination light, and general lighting.
Lamps:
Four 20-watt fluorescent
Three 40-watt fluorescent
One 6-watt incandescent
Brigiit?iess :
Footlamberts measured at intervals across
ceiling, walls, and face of luminaire indi-
cated by numerals in circles and squares.
The numerals in squares indicate excessive
brightnesses.
Illumination:
Lighting levels in footcandles indicated by
numerals on bed and reading matter.
Interior finishes:
Colors and reflectances: Head walls red,
26 percent; ceiling gray, 70 percent,
Remarks:
The fluorescent lamps are switched to pro-
vide the following combinations of lamps
for general, reading, and examination
lights: two 20-watt general, four 20-watt
reading, four 20-watt, and three 40-watt
examination. The lighting provided by
these lamp combinations for the services
stated produces the lighting levels recom-
mended, but the brightnesses are excessive.
The large lighted area provided by the read-
ing light allows the patient considerable
freedom of movement within the area
lighted for reading. However, the night-
light, located at the foot end of the lumi-
naire, exceeds the brightness recommended.
Its brightness and location are objection-
able to most observers.
12
Figure 5. Ceiling-suspended concentric-ring luminaire, indirect lighting.
Service;
General lighting
Lamps:
One 150-watt incandescent, silver bowl, con-
trolled by high-low switch.
Brightness:
Footlamberts measured at intervals across
ceiling and wall indicated by numerals in
circles and square. The numeral in square
indicates excessive brightness,
Illumination:
Lighting intensities in footcandles indi-
cated by numerals on beds and reading
matter.
Inferior Finishes:
Colors and reflectances: Head wall blue,
40 percent; ceiling white, 80 percent,
Remarks :
This light controlled by a high-low switch,
provides two lighting levels. In the sketch
are shown lighting levels and brightnesses
as produced with a high-low switch in
"high" position. When the switch is in
"low" position these levels and bright-
nesses are reduced about 70 percent,
Viewing Position
CJ Footlamberls
Excessive Footlamberts
Figure 6, Ceiling-suspended luminatre with plastic diffusing louvers, indirect lighting.
Viewing Position
Footlamberts
Excessive Foot lam berls
Service;
General lighting
One 500-watt incandescent, silver bowl,
dimmer controlled,
Brightness:
Footlamberts measured at intervals across
ceiling and wall indicated by numerals in
circles and square. The numeral in the
square indicates excessive brightness.
Illumination:
Lighting levels in footcandles indicated by
numerals on beds and reading matter.
Interior Finishes:
Colors and reflectances: Head wall blue,
40 percent; ceiling white, 80 percent.
Remarks :
The lighting levels produced by this lum-
inaire are controlled by a dimmer which
permits adjustments over a range from
to 50 footcandles at bed level, 30 inches
above the floor. When the dimmer is ad-
justed to provide 12^ footcandles at bed
level, the brightnesses are as shown above,
When the light is adjusted by the dimmer
to provide the lighting levels recommended
for reading or for examinations, bright-
nesses on ceiling and walls exceed the limit
recommended.
14
Figure 7. Ceiling-suspended luminaire with opaque shade.
Service;
General lighting
Lamp :
One ISO-watt incandescent, controlled by
high-low switch, general lighting.
Brightness:
Footlamberts indicated by encircled nu-
merals for high and low positions of switch,
Illumination;
Lighting levels in footcandles shown at
points indicated.
Interior Finishes :
Colors and reflectances; Head wallred,
26 percent; side wall gray, 60 percent;
ceiling white, 80 percent.
Remarks :
This luminaire is suspended from the cen-
ter of the ceiling of a 4-bed ward and is
controlled by a high-low switch. When the
switch is in "high" position, this unit pro-
vides 10 footcandles 30 inches above the
floor over a large area and has a cutoff of
direct view of the lamp at about knee posi-
tion' on the beds. When the switch is in
"low" position, 3 footcandles are provided.
The usefulness of this type of luminaire is
limited by low ceiling height. However,
the indirect lighting reflected from the ceil-
ing, plus the direct lighting confined to a
wide control area, produce a restful and
pleasant environment.
85) fL-SwItch High
25) fL-Switch Low
Viewing Position
(___) Footlamberts
15
Figure 8. Ceiling-mounted floodlights: experimental lighting unit.
*70fL inside edge of shade
,30 fc Reading
Service :
Combination reading and examination
lights: Study assembly of two swivel-type
adjustable hooded downlights.
Lamps:
One ISO-watt reflector flood.
watt projector flood.
One 150-
lllumination:
Footlamberts measured at inside bottom
edge of shade. Lighting levels in foot-
candles are indicated by numerals on bed
and reading matter.
Interior Finishes:
Colors and reflectances: Head wall blue,
40 percent; ceiling white, 80 percent.
Remarks:
This experimental unit, consisting of flood-
lights attached to a bus mounted on the
ceiling, permits adjustment of the spacing
between the downlights and the direction
of the light beam. The purpose of this
lighting unit was to determine the charac-
teristics and usefulness of similar ceiling-
mounted units when used for reading and
examination lights. When the reading
unit is adjusted to angle the beam forward,
as shown, additional shielding is necessary
to protect patients on the opposite side of
the room from excessive brightness. This
type of reading light with no background
illumination produces an unpleasant light-
ing environment.
16
Figure 9. Wall-mounted bracket light with translucent shade, indirect lighting.
Service;
Combination reading light, nightlight, and
indirect light for general illumination.
Lamps:
One 75-watt incandescent, for general light-
ing. One 100-watt incandescent, for read-
ing. One 6-watt incandescent nightlight.
Brightness:
Footlamberts measured at intervals across
ceiling and wall indicated by numerals in
circles and squares. The numerals in the
squares indicate excessive brightnesses.
Illumination:
Lighting levels in footcandles indicated by
numerals on beds and reading matter.
Interior Finishes:
Colors and reflectances; Head wall- blue,
40 percent; ceiling white, 80 percent.
Remarks:
The adjustable rending light provides ade-
quate illumination, but the luminaire may
be maladjusted and thus shine in another
patient's eyes* The brightness of the trans-
lucent shade of the general lighting com-
ponent exceeds the limit recommended.
The night lighting component of units of
this type provides inadequate illumination
for nurses to see furniture or other objects
on the floor.
Viewing Position
Footlamberts
Excessive Rrotlamberts
17
Figure 10. Watt-mounted bracket light with opaque shade, indirect lighting
Viewing Position
Q FootlambGrts
Service;
Combination reading light, nightlight, and
indirect light for general illumination.
Lamps:
One 75-\vatt incandescent, for general
lighting
One 60-watt incandescent, for reading
One 6-watt incandescent nightlight
Brightness;
Footlamberts measured at intervals across
wall and ceiling indicated by encircled
numerals.
Illumination:
Lighting levels in footcandles indicated by
numerals on beds and reading matter.
Interior Finishes;
Colors and reflectances: Head wall red,
26 percent; ceiling white, 80 percent.
Remarks:
The adjustable reading light, which is not
fixed to the wall bracket provides adequate
illumination and is essentially a portable
unit provided with a bayonet-type fitting
that may be inserted into any available
socket, such as in a wall bracket, clamp-on
bracket, intravenous rod receptacles on the
corner of beds, or on a heavy base placed
on a bedside table or dresser. Although
it is possible to maladjust the light to shine
in another patient's eyes, the unit is con-
structed to minimize this probability. The
general lighting component does not pro-
vide the recommended illumination. Ob-
servation pertaining to the nightlight is
similar to that stated for figure 9,
18
Figure 11. Wall-mounted himinaire, fluorescent and
incandescent, including examination light.
Service;
Combination reading, examination, and
semi-indirect light for general illumination
Lamps ;
Two 40-watt fluorescent (deluxe warm),
for general lighting
One 20-watt, 28-volt incandescent, for
reading
Two 20-watt, 28-volt incandescent, for
examination
Brightness:
Footlamberts measured at intervals across
wall and ceiling indicated by encircled
numerals,
Illumination:
Lighting levels in footcandles indicated by
numerals on beds and reading matter.
Interior Finishes;
Colors and reflectances: Head wall blue,
40 percent; ceiling white, 80 percent.
Remarks ;
The level of general lighting, provided by
the two fluorescent lamps, is within the
limit recommended. This light is well dif-
fused and distributed over a large area of
wall and ceiling. The reading light, pro-
vided by one 20-watt lamp mounted on an
adjustable arm, permits the patient to ad-
just the light to suit the reading position
selected. However, the light may be mal-
adjusted to shine in another patient's eyes.
The examination light, provided by two
20-watt lamps on another adjustable arm,
permits positioning of the light as needed
by the nurse or the doctor. This light also
is subject to maladjustment, as pointed out
for the reading light. Both reading and
examination lights provide the recom-
mended lighting levels.
Examining Light
(75 fc at 14-Inch distance)
Viewing Position
Footlamberts
19
Figure 12. Wall-mounted luminaire, incandescent.
Service:
Combination reading light, nightlight, and
indirect light for general illumination.
Lamps:
One 100-watt incandescent, for general
lighting
One 100-watt incandescent, for reading
One 6-watt nightlight
Brightness:
Footlamberts measured at intervals across
ceiling and wall indicated by encircled
numerals.
Illumination:
Lighting levels in footcandles indicated by
numerals on beds and reading matter.
Interior Finishes:
Colors and reflectances; Head wall blue,
40 percent; ceiling white, 80 percent,
Remarks:
The nonadjustable reading light provides
adequate illumination; however, it is lim-
ited to a predetermined area. The gen-
eral lighting level is less than that rec-
ommended when using a 100-watt lamp.
If a 150-watt lamp is used, the illumina-
tion is sufficient but the brightnesses of the
ceiling and wall are excessive. The night-
light features are the same as described for
figure 9,
Figure 13. Wall-mounted luminaire^ fluorescent.
Service:
Combination reading and indirect light for
general room illumination
Lamps:
One 40-watt fluorescent, for general light-
ing
One 40-watt fluorescent, for reading
Brightness:
Footlamberts, measured at intervals across
ceiling and walls, indicated by encircled
numerals. The numeral in the square in-
dicates excessive brightness.
I Humiliation:
Lighting levels in footcandles indicated by
numerals on beds and reading matter.
Interior Finishes:
Colors and reflectances: Head wall blue,
40 percent; ceiling white, 80 percent.
Remarks:
This type of luminaire provides the light-
ing level recommended for reading, and
spreads the light over a relatively large
area, as is desirable for this purpose. How-
ever, the brightness, as viewed from an ad-
jacent bed or the bed on the opposite side
of the room, greatly exceeds the recom-
mended limit. The level of the general
lighting provided by one fluorescent lamp
is below that recommended; however, with
both fluorescent lamps on, the general light-
ing level is within the limit recommended.
. ._ Viewing Position
O Footlamberls
PI Excessive Footlaniberts
21
Figure 14. Wall-mounted bracket louvered reading light.
Viewing Position
Footl amber ts
Excessive Foottamberts
Service:
Reading light with indirect general lighting
component
Lamps:
Two 20-watt fluorescent
Brightness:
Footlamberts measured at intervals across
ceiling and wall indicated by numerals in
circles and square. The numeral in the
square indicates excessive brightness.
Illumination;
Lighting levels in footcandles indicated by
numerals on beds and reading matter.
Interior Finishes:
Colors and reflectances: Head wall red,
26 percent; ceiling white, 80 percent.
Remarks:
This type of luminaire provides the lighting
level recommended for reading and spreads
the light over a relatively large area, as is
desirable for reading. However, the
brightness, as viewed from on adjacent bed
or the bed on the opposite side of the room,
greatly exceeds the recommended limit.
22
Figure 15. Floorlamp portable-type luminaire.
Service:
Heading, general illumination, examina-
lion, nnd nightlighl
incandescent, for general
for general
One 100-wntt
lighting
One 6-wntl incandescent,
lighting
ttrightness:
I'Wlamborts measured on coiling and in-
side bottom edgo of shade are indictiLcd by
numerals in circle nnd square. The nu-
meral in the square indicates excessive
brightness.
Illumination;
Lighting level in footeandles indicated by
numeral for reading matter.
Interior Finishes;
Colors and reflectances: Head wall blue,
40 percent; coiling white, BO percent.
Remarks;
This Unninairo is provided with a reflector
unit that may bo adjusted for reading, ex-
amination, or general lighting. When the
shade is properly adjusted for reading, this
fixture provides the recommended illumi-
nation, but if maladjusted, can cause dis-
comfort glare to other patients. When the
shade is Adjusted for cither examination or
general lighting, the lighting levels are be-
low the values recommended for these
services. The nightlight in the base of the
lamp reflcclB light parallel to the floor, but
is limited to a small area. The connecting
cord for this type of light is an undesirable
dust catcher and tripping hazard,
Viewing Position
Footlamberls
Excessive Footlamberls
23
Figure 1 6. Wall-mounted nightlight ivith crystal glass prismatic lens.
Service;
Nightlight
Lamps:
One 10-watt incandescent, controlled by a
high-low switch
Brightness;
Footlamberts taken one foot from edge of
luminaire are indicated by numerals on
wall; footlamberts taken on face of lumi-
naire from positions A, B, G at 3 feet 6
inches from floor are shown in table below.
FOOTLAMBERTS on FACE of
LUMINAIRE
Viewing
position
A
B
G
Switch on
high
position
80
50
30
Switch on
low
position
25
15
10
Illumination:
Lighting levels in footcandle readings on
floor as indicated. The maximum illumi-
nation with switch in "high" position is
2.5 fc.
Interior Finishes:
Colors and reflectances: Floor tan, 25
percent; wall on which nightlight is
mounted gray, 50 percent; wall opposite
nightlight gray, 60 percent,
Remarks:
To provide enough light for the nurse en-
tering the room from a lighted corridor,
but to minimize interference with the pa-
tients' sleep or rest, two levels of night-
lighting are recommended. The nightlight
illustrated is controlled by a high-low
switch. When the switch is in "high" po-
sition, lighting levels at the floor are as
shown ; and when the switch is in the "low"
position, these levels and brightnesses are
considerably reduced,
Figure 17, Wall-mounted nightlight, lo u v ered , wit h stain l ess stee l f
ace finish.
Service;
Nigbtlighl
Lamp:
One 15-wntl incandescent, controlled by a
high-low switch
ftrightness:
Foollamberts tnken one foot from edge of
luimimiro arc indicated by nunicrnls on
wall; foollnmburls token on face of lumi-
nniro from positions A, II, C at 3 feet 6
inches from floor tiro shown in inblo holow.
FOOTLAMJJKKTS on FACK of
LUMINA1HK
Viewing
position
A
JB
10
C
Switch on
high
position
15
10
Switch on
low
position
5
2.5
2.5
Illumination:
Lighting levels in foolcondlc readings on
floor aa indicated. Tho maximum illumi-
nation with Rwito.li in "high" position is
3 fc.
Interior Finishes ;
Colors and reflectances: Floor tan, 25 per-
cent; wull on which nightlighl is mounted
gray, 50 percent; wall opposite nightlight
gray, 60 percent.
Remarks;
To provide enough light for the nurse en-
tering the room from a lighted corridor, hut
to minimize interference witli the patients'
rest or sleep, two levels of nighllighting arc
recommended. Tho nightlight illustrated
is controlled by a high-low switch. When
the switch is in "high" position, lighting
levels at the floor are as shown; and when
the switch is in the "low" position, these
levels and brightnesses are considerably
reduced.
Viewing Positions
O Footlamborls
WUIS fc I'll 1 !>*<?.' M- V> i" ll" 1 '." :r!,'*! . ' nd
!?$|
fcyri'jj'^' :tfn
25
Figure 18. Wall-mounted nightlight, louvered with matte black face finish.
Service:
Nightlight
Lamp:
One 15-watt incandescent, controlled by a
high-low switch
Brightness;
Footlamberts taken one foot from edge of
luminaire are indicated by numerals on
wall; footlamberts taken on face of lumin-
aire from positions A, B, C at 3 feet 6
inches from floor are shown in table below.
FOOTLAMBERTS on FACE of
LUMINAIRE
Viewing
position
A
B
C
Switch on
high t
position
2
1.5
1.5
Switch on
low
position
0.6
0.4
0.4
Illumination:
Lighting levels in footcandle readings on
floor as indicated. The maximum illumi-
nation with switch in "high" position is
3 fc.
Interior Finishes:
Colors and reflectances: Floor tan, 25
percent ; wall on which nightlight is
mounted gray, 50 percent; wall opposite
nightlight gray, 60 percent.
Remarks:
To provide enough light for the nurse en-
tering the room from a lighted corridor,
but to minimize interference with patients'
rest or sleep, two levels of nightlighting are
recommended. The nightlight illustrated
is controlled by ft high-low switch. When
the switch is in "high" position, lighting
levels at the floor are as shown; and when
the switch is in the "low" position, these
levels and brightnesses are considerably
reduced.
26
Lighting Affected by Surface Finishes
The effects on brightnesses of wall 01 ceiling finishes
that may result from redecorating, or even from fading of
colois of original finishes, also should be considered in the
design of lighting systems. As an example, a blue wall
in one of the mock-up rooms had an original brightness
of 85 footlamberts when lighted with a particular lurni-
naire. After four months this wall had faded enough so
that its brightness had increased to 100 footlambeits when
lighted with the same luminaire, The data in table 2 give
the differences of values for reflectances and brightnesses
of ceiling and wall color finishes, as produced by the same
light source.
Table 2. Reflect mute and brightness values (determined for various luminaire types)
Table 2a. Reflectance and biightness values of a specific
area on the ceiling, lighted as in figure 5, with 150-watL
silver-bowl lamp in ceiling-suspended concentric ring-type
luminaire.
Ueflerlimt'c
Ceiling color (percent)
Brightness
(footlunihcrla)
Blue, dark
20
65
50
60
17
37
6
83
70
4-5
130
75
110
60
100
20
170
140
Blue, light
Green, medium
Red, dark-..
Yellow-red, medium dark
White, light
Grav. Heli 1 _. -,
Table, 2c. Reflectance and brightness values of a specific
area on the wall one foot above luminairo, lighted as in
figure 11, with two 40-watl fluorescent (deluxe wurm)
lamps in a wall bracket with diffusing plastic covers.
Reflectance
Wall color (percent)
Brightness
(foolltmiberls)
20
40
50
65
50
60
17
37
6
83
40
85
100
. 120
70
no
35
60
7
200
Blue, light
Yellor-red, medium dark
White, light __.
Table 2b. Reflectance and brightness values of a specific
area on the wall one foot above luminaire, lighted as in
figure 9, with 100-watt incandescent lamp in a wall-
bracket uptight with translucent plastic shade.
Reflectance
Wull color (percent)
Brightness
(foollnmberts)
Blue, dark
20
40
50
65
50
60
17
28
37
6
83
60
50
75
110
160
220
140
180
90
130
130
20
320
210
200
Blue, medium dark
Blue, light __
Green, medium
Watermelon, medium
dark red
Yellow-red, medium dark
Black, dark
White, light
Table 2d, Reflectance and brightness values of a specific
area on the wall one foot above luminaire, lighted as in
figure ]2, with 100-watt incandescent lamp in a wall-
bracket uptight, totally indirect.
Reflectance
Wall color (percent)
Brightness
(foollnmlierls)
20
40
50
65
50
60
17
37
6
83
60
100
150
200
120
170
55
95
10
300
Blue, light
Yellow-red, medium dork
White, licht
27
ADVISORY RECOMMENDATIONS
Discomfort glare produced by excessive brightness
a common and primary source of complaint in patient
ioms. Designers should be cognizant of the effects of
)lor and reflectances of interior finishes which contribute
i the degree of brightness produced by lighting. Glossy
nishes should be avoided.
If fluorescent lamps are used in patient rooms, they
lould be of the deluxe (warm or cool white) type,
'eluxe-type fluorescent lamps are considered satisfactory
>r use in patient rooms. However, in relamping, the
imps may mistakenly be replaced by any one of a number
E color tones other than those for which the system was
ssigned.
reneral Lighting
General lighting should be indirect or so designed
lat the brightness of any luminaire or interior finish does
Dt exceed 90 footlamberts when viewed from any normal
i-bed position.
The general illumination should be produced by one
more luminaires having the capacity to provide a mini-
um of 10 footcandles 30 inches above the floor, hut
Lould not greatly exceed 10 footcandles for normal use,
ontrol equipment is recommended for dimming the il-
mination to create a soft light for the patient's rest and
taxation.
To prevent excessive spottiness of general lighting
the room, the installation should provide a lighting
vel ratio of less than. 1 to 5 on a horizontal plane 30
ches above the floor within a radial distance of 8 feet
om the maximum lighting level on that plane.
eading Light
The reading tight should be capable of providing
>out 30 footcandles but not less than 20 footcandles at
e normal reading position, assumed to be 3 feet 9 inches
>ove the floor. To allow the patient some freedom to
rn in bed without moving out of the reading light zone,
e area of the reading plane lighted by an adjustable-
pe unit should be approximately 3 square feet, and for a
madjustable-type unit the area should be approximately
square feet. To provide a reasonable degree of uni-
rmity oi lighting over these recommended areas, the
J
lighting level at the outer edge of each area should be not
less than two-thirds of the lighting level at the center of
the area.
To provide comfortable lighting conditions for read-
ing, the brightness in footlamberts on the ceiling, provided
by some means of general lighting, should be at least equal
to the illumination in footcandlea on the reading matter.
Observation Light
An observation light should be installed or provided,
when needed, for the nurse who must make relatively fre-
quent observations of a patient or of treatment equipment.
This luminaire should be positioned to light the bed area
and the equipment to about 2 footcandles but not less than
1 footcandle. As this light may be left on all night, if
necessary, screens or other means should be provided to
shield the light from other patients.
Examination Light
The examination light should provide not less than
50 footcandles, preferably 100 footcandlea or more, and
be of a type or so arranged to minimize shadows at the
area of interest. To reduce glare and to minimize "spill
light" that may affect others in the room, this light should
be shielded or adjusted to confine it to the bed area of the
patient being examined or treated,
Nonadj ustable examination lights should light the
bed area to a degree of evenness so that the lighting level
does not vary more than 2 to 1 over the entire bed area.
Adjustable examination lights should be capable of
producing the recommended lighting levels in the center of
a circular area 2 feet in diameter, at a distance of not
less than 2 feet from the light source enclosure, and at
least half the level at the outer edge.
Portable examination lights should be capable of light-
ing performance similar to that described above for ad-
justable units.
Because the illumination requirements for examina-
tions and nursing service vary over a wide range, ar-
rangements for dimming the lights might be considered.
However, since an examination light is ordinarily used
infrequently and for relatively short periods, the added
cost of providing dimming controls is generally not
justifiable.
The light level and effective color of the examination
light should be adequate to permit rapid and correct
evaluation of the patient's condition as judged from color
or condition of the patient's skin or tissue. It is gen-
erally agreed that the color and quality of daylight, under
specific conditions, are superior to that of electric light
for most color classification tasks. Daylight itself is vari-
able, often not available, and electric lighting of this
color and quality (the order of 6500 K) appears quite
blue unless the viewer's eyes are adapted to this light alone
after individually variable periods of work under it. Con-
sequently, daylight color and quality of electric lighting
(6500 K) is not a justifiable requirement for patient
rooms. In most cases, satisfactory lighting can be pro-
vided for examination of patients in bedrooms by use
of commercially available incandescent filament lamps
and deluxe-type fluorescent lamps that are within the color
temperature range of 2950 K to 4500 K. Daylight in-
candescent filament lamps (approximately 4000 K) and
deluxe cool-white fluorescent lamps (approximately 4200
K) fall within this range. Also, the recommended color
may be obtained by use of fixed examination lights aided
by other lamps and commercially available filters.
Nightlight
Nightlights are needed to provide only a low level
of illumination; therefore, the brightness of the luminaire
and its immediate surroundings should be low enough in
brightness-contrast to minimize discomfort to the pa-
tients. Accordingly, it was found that the brightness of
the nightlight luminaire should not exceed 20 footlam-
berts. However, if this brightness provides insufficient
illumination for the nurse, a brightness up to 60 foot-
lamberts and correspondingly higher footcandles may be
tolerated by the patient for momentary use. Brightnesses
in this lange may be provided by a suitable control switch,
such as a rectifier -type dimming switch mounted at the
door, convenient for the nurse to switch to the higher
lighting level as she enters the room and back to the
lower level as she leaves the room.
Nightlights that utilize louvers through which the
light is emitted should be so constructed or so installed
that there will be no direct view of the light source from.
a normal in-bed position. The surface finish of the
nightlight should be such as to have a very low brightness
value at all times.
Appendix A. Medical and Related Needs for Lighting in a Patient
Room in a General Hospital
Appendix B. Selected Bibliography
Appendix A
MEDICAL AND RELATED NEEDS FOR LIGHTING
IN A PATIENT ROOM IN A GENERAL HOSPITAL
by
BRUCE UNDERWOOD, M.D., Senior Surgeon (R)
Professional Services Branch, Public Health Service
This study emphasizea lighting requisites primarily
from the viewpoint of the clinical needs and care of the
patient and includes the activities of those persons in-
volved in rendering service to or for the patient in the
patient's room. The following analysis is a summary of
the various conditions for which light is needed in the
patient's room, It includes a comprehensive listing of
the activities frequently or occasionally performed in a
patient room, including those of patient, physician, nurse,
technicians, maintenance people, and visitors.
The information is summarized under four categories,
as follows ;
Section- No.
I
II
III
IV
Category
General factors
Kinds of light needed
People needing light
Activities for which light
is needed
SECTION I. GENERAL FACTORS
Of all the lighting systems used in a general hospital,
probably those provided in the patient rooms have created
the most concern. As far as we can determine, no known
lighting systems are entirely satisfactory for these areas.
Systems designed to triple or quadruple lighting levels
often defeat their basic purpose, introduce glare, lead to
complaints, and may lower human efficiency.
Formerly, light selection and design apparently were
based on such notions as good taste, personal feelings, or
the application of rules to establish definite levels of foot-
candles. For present and future needs, the designing and
selection of light for ideal light balance should be con-
sidered for brightness and color control in the environ-
ment, as well as for other specific factors.
The many current developments in clinical and ad-
ministrative practices, summarized below, are significant,
and indicate the quantity and quality of lighting needed.
A. Changes in clinical practices
1. Early ambulation: More patients are up and moving
about in their rooms during the major period of their
hospitalization, whereas formerly most patients were kept
in bed until a day or two prior to their discharge from the
hospital.
2. Patient self-care: Combined with the practice of
early ambulation, patients are encouraged to be active
during their hospitalization. As a result, patients now
attend to more aspects of personal care.
3. Implementation of new diagnostic procedures and
the availability of mobile equipment: Many services and
procedures, such as blood chemistry, basal metabolism,
electrocardiography, and X-rays, now are being performed
in patient rooms instead of transporting the patient to the
laboratory or other diagnostic areas.
4. Use of new drugs; The administration of many new
drugs requires frequent dosage and the use of hypodermic
needles, thus increasing the need for light in order to find
the site of injection and to observe patient reaction.
B. Changes in administrative practices
1, Varied personnel: Employment of many kinds of
personnel such as aides and special therapists and greater
use of part-time workers and volunteers for various tasks.
2. Visitors and patients: More lenient visiting hours
and less restriction of visitors for patients have increased
significantly the general flow of numerous persons to
32
patient rooms. Also, as a result of the practice of early
ambulntion, more patients visit each other's rooms or con-
tinue their business functions either with visiting associ-
ates or via telephone.
3, Safety precaution; As a corollary to public educa-
tion regarding accident prevention, hospitals have imple-
mented safety programs, including increased use of light,
which help to avoid litigation.
C. Other factors
1. Aging population and increased age of retirement
indicate an increase in the percentage of older patients,
nurses, and other personnel rendering service; the de-
crease in their visual acuity must be considered.
2. Availability of greater quantities of reading matter
for patients.
3. Trend for hospitals to use more printed materials to
inform and instruct patients.
4. Use of color in lighting to enhance the appearance
of the area and to create a psychologically pleasing
environment.
SECTION II. LIGHTING SERVICES
SECTION III.
LIGHT
PEOPLE NEEDING
In addition to the patient, there are a variety of
individuals needing light in the patient's room. The fol-
lowing list indicates the range of persons who visit this
area:
Physicians (includ-
ing surgeons, an-
esthesiologists,
dentists)
Nurses
Dietitians
Therapists
Social workers
Technicians (X-ray
laboratory)
Housekeeping
personnel
Maintenance
personnel
Administrative
personnel
Visitors
SECTION IV.
ING LIGHT
ACTIVITIES REQUIR-
The diversity of the people who have reason to be in
the patient's room makes it pertinent to examine some of
their specific activities in order to analyze the extent of
lighting that may be required. The activities of the pa-
tient, the physician, and the nurse are enumerated below;
within each group a few examples ate given to illustrate
some of the details involved.
The lighting services needed generally are classified A. Patients
as:
General illumination
Reading light
Examination light
Nightlight
Special lighting features occasionally are needed for
patients. For example, for patients following ocular
surgery, provision should be made to attain a low lighting
level, devoid of high brightness or glare. Some patients
require special reading devices, such aa projector light for
patients on Stryker frames, Reading lights should be
provided for bedpatients and for patients in chairs.
Local lighting or special-use lighting may be needed
for certain types of equipment or for observation.
1, Sel/'care;
Getting out of bed; attending to personal hygiene and
grooming; obtaining and using articles on bedside
table; locating and selecting clothing which involves
looking for items in dresser drawers or closets; dressing.
2. Use of equipment:
Reading projectors, telephone, radio, television.
3, Visitors;
Personal, business, stenographic, clerical.
4. Social activities:
Playing cards'; visiting and conversing with other
patients.
33
Location:
Signal lights, doorways, toilet rooms, lavatories, bedside
table.
Disposal of contaminated articles;
Handkerchiefs,
Walking in room:
Avoiding possibility of stumbling over objects such as
rugs, chairs, and other furnishings,
Other activities ;
Eating, smoking, reading, writing, needlework.
. Physicians
1. Medical rounds:
a. General observation or examination of patient
b. Specific physical examination of patient
c. Write or read medical orders
d. Instruct nurae or patient
e. Gown and wash hands prior to treating patient,
performing procedure, or to care for isolated
patient
f. Treat specific body parts
2. Medical history:
a. Read identification materials (name tag on bed,
admission data on chart, history of former hos-
pitalized periods, reports or data from referral
agency or physician)
h. Interview, converse with, and observe patient
behavior, reactions, and physical appearance
c. Write notations on medical record
3. Consultation:
a. Read patient's identification and medical rec-
ord data
b. Observe patient, examine, or treat specific body
parts
c. Converse with other physicians and with patient
d. Position or arrange patient for examination or
treatment
e. Arrange and use instruments and medicinal
agents (involves reading fine graduations on
syringes or closely observing amount of agent
drawn)
f. Observe patient's response to medication or
treatment
g. Check drainage and adjust treatment apparatus
h. Look at X-iays
i. Write notations on medical record
4. Procedures;
a. Measurement of blood pressure (read and record
measurement, remove and return equipment to
container)
b. Obtain specimens for diagnostic tests
c. Perform gavage, lavage, paracentesis
d. Apply, remove, or adjust casts, splints, and other
orthopedic appliances or dressings
C. Nurses
1. General care;
a. Admit and receive new patient
b. Prepare patient bed unit
c. Prepare patient (undress, dress, arrange for
safekeeping of personal belongings)
d. Assist or administer personal care (bathe, sham-
poo, comb hair, direct oral hygiene)
e. Help patient into or out of bed or chair
i. Give or remove bedpan or urinal
g. Prepare patient for meals and nourishments;
assist, serve, or feed patient
h. Visit and/or observe patient for needs
i. Inspect patient rooms (tiny bedside tables,
dressers, other furnishings j remove soiled
linen and articles to be discarded)
j. Check equipment and apparatus
2 Administration of medicine:
a. Read patient's identification
b. Select right medication from carts or trays for
administration to patient
c. Give or assist patient receiving medication
(orally, hypodermically, application)
d. Record notes {medication given, patient's re-
sponse)
3. Observations and data recording:
&. Note progress of patient (skin color, restless-
ness, respiratory functioning, reaction to medi-
cations and treatments; if obstetrical patient,
note contractions and other symptoms)
b. Observe fluid intake, col'or and quantity of urine,
vomitus, or feces
4. Assist physician(s) during examinations, proce-
dures, or treatments:
a. General or specific examination (eyes, ears, vag-
inal, proctoscopic)
b. Procedures such as aspiration, gavage, lavage,
vena puncture, lumbar puncture, abdominal
paracentesis
c. Apply, remove, or adjust appliances and equip-
ment (casts, splints, and other orthopedic appli-
ances; bandages, restraints)
5. Other phases of nursing care, specific treatment,
procedures, or assistance:
a. Take temperature (oral, axilla, rectal), pulse,
and respiration:
1) Identify patient; inspect thermometer to de-
tect imperfections or broken tips
2) Insert or place thermometer; observe pa-
tient's condition ; observe watch and patient
to obtain accurate pulse and respiration
rates ; read fine graduations on thermometer
3) Clean thermometer; record observations on
chart
b. Prepare patient for catheterization and/or blad-
der irrigation:
1) Identify patient; arrange tray and other ar-
ticles; prepare and drape patient; cleanse
and prepare specific site area
2) Manipulate catheter and equipment for with-
drawal of urine ; introduce solution ; observe
flow of urine for collecting in receptacle;
check amount of solution introduced and
return flow
3) Handle and manage safely the removal of
receptacle and equipment from bed; reas-
semble equipment on tray
4) Care of patient and bed after treatment
5) Prepare specimen for laboratory (transfer
urine to container, label specimen)
6) Record treatment and data on medical chart
or forma
7) Transport (carry or by other means) equip-
ment tray and articles from patient's room,
avoiding stumbling or tripping over
furniture
c. Care during specific situations:
1) Prepare bed unit for return of patient from
operating room, recovery room, delivery
room, treatment areas, X-ray
2) Presurgery; post-anesthesia; shock recov-
ery; tracheotomy; if obstetrical patient, pre-
pare for delivery and after delivery
3) Observe equipment and apparatus (heat
cradles, oxygen tent or respirator, orthopedic
appliances)
4) Apply compresses, surgical dressings, bind-
ers, ice collars, electric pads
5 ) Assist or instruct patient in walking with or
without orthopedic appliances
6) Care during transfer from bed to stretcher
or during early ambulation
7) Bathe, dresa, feed infants or children
8) Orient and instruct patient prior to treatment
9) Instruct others of specific nursing procedures
or general care
10) Arrange for removal' of deceased patients
d. Assist, start, check, or terminate procedures and
treatment:
1) Postural drainage; tidal drainage
2) Hypodermoclysis; intravenous solutions
3) Wangensteen suction ; Levine tube
4) Aerosol therapy; oxygen or steam inhala-
tion
5) Diathermy; light treatment
6) Therapeutic bed baths; immersion of body,
or arm or foot soaks
7) Enemas; perineal care
8) Installations and irrigations of ear, eye,
throat, colostomy
35
Appendix B
SELECTED BIBLIOGRAPHY
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Beny, R. C., "Modernized Lighting for Surgery,"
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Birren, Fafaer and Logan, H. L., "Agreeable Environ-
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Blumenauer, G., and Campbell, Coyne H., M.D., "Color
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116:217-220, October 1954
Griffin, Noyce L., "Recommended Lighting Practices
Put the Hospital in Its Best Light," Modern Hospital,
84:84, March 1955
Haynes, Howard, and Staley, K. A., "Reflections on
Hospital Lighting, Part 4, Patients' Rooms and Wards,"
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dian Hospital, 22:50, October 1945
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Institutions, 33:67-9, August 1953
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61:128-9, June 1946
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Point of View," Hospital and Health Management Lon-
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luminating Engineering, XLVI-10, October 1951
36
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NOTE; Inquiries relating to the above publications sbould be directed to the sources indicated.
37
U S. GOVERNMENT PRINTING OFFICE : 1902 O 845348
The categories of publications include! 1 in the Hospital and Medical
Facilities Series* under the Hill-Burton Program follow;
A- Keg ulntiona
B- Community Planning
G - -Organization and Administration
5)- Design and Equipment
E Research and Demonstration
Jj\ Reports and Analyses
G Jiibliography
An annotated bil)Hography of these publicatioiiH will be provided
upon request. Inquiries should be addressed to :
Division of Hospital and Medical Facilities
Public Health Service
U.S. Department of Health, Education, and
Washington 25, D.C.